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Individual

MR. JESSE RICHARDS RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
L.C.S.W.

Contact information

Practice address
106 MAQUOIT DR, FREEPORT, ME 04032-6320
(207) 671-5598
Mailing address
PO BOX 597, FREEPORT, ME 04032-0597
(207) 671-5598

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC 5397
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
285810099
ME
Enumeration date
11/13/2007
Last updated
09/10/2025
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